Provider Demographics
NPI:1346349289
Name:SIMPSON, AMY KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ROSELAND BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-533-0644
Mailing Address - Fax:903-533-0441
Practice Address - Street 1:1910 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-533-0644
Practice Address - Fax:903-533-0441
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88734YOtherBCBS
F18816Medicare UPIN
TX8549K5Medicare PIN